92 0 obj <>stream This payment covers the same items and services as defined in section 1861(iii)(2)(A) and (B) of the Act, furnished in coordination with the furnishing of transitional home infusion drugs. These commenters requested that home infusion therapy suppliers be permitted to bill all MACs from a single location: (1) Without having to maintain fixed sites in every applicable MAC jurisdiction or state; and (2) with a single National Provider Identifier (NPI). 1503 & 1507. If a home health claim is submitted with a principal diagnosis that is not assigned to a clinical group (for example, because the diagnosis code is vague, ill-defined, unspecified, or is subject to certain ICD-10-CM coding conventions), the claim is returned to the provider for more definitive coding. The Bureau of Labor Statistics (BLS) is the agency that publishes the official measure of private nonfarm business MFP. A nurse is paid $30 per visit completed; in week 1 she completes 5 visits and is paid $150 for that week, in week 2 she completes 30 visits and is paid $900 for that week. Therefore, we created a new HCPCS G-code for each of the three payment categories and finalized the billing procedure for the temporary transitional payment for eligible home infusion suppliers. L. 111-148). The summarized comments and responses related to the separation of home infusion therapy services benefit from the HH PPS are found in section V.A.5 . Currently, as set out at section 1834(u)(7)(D) of the Act, each temporary transitional payment category is paid at amounts in accordance with six infusion CPT codes and units of such codes under the PFS. The documents posted on this site are XML renditions of published Federal We also finalized the proposal to increase the payment amounts for each of the three payment categories for the first home infusion therapy visit by the qualified home infusion therapy supplier in the patient's home by the average difference between the PFS amounts for E/M existing patient visits and new patient visits for a given year, resulting in a small decrease to the payment amounts for the second and subsequent visits, using a budget neutrality factor. The overarching purpose of the enrollment process is to help confirm that providers and suppliers seeking to bill Medicare for services and items furnished to Medicare beneficiaries meet all federal and state requirements to do so. Section 51001(a)(2)(A) of the BBA of 2018 added a new subclause (iv) under section 1895(b)(3)(A) of the Act, requiring the Secretary to calculate a standard prospective payment amount (or amounts) for 30-day units of service, furnished that end during the 12-month period beginning January 1, 2020, in a Start Printed Page 70302budget neutral manner, such that estimated aggregate expenditures under the HH PPS during CY 2020 are equal to the estimated aggregate expenditures that otherwise would have been made under the HH PPS during CY 2020 in the absence of the change to a 30-day unit of service. In addition, for both the submission of the RAP in CY 2021 and the one-time NOA for CYs 2022 and subsequent years, we finalized a payment reduction if the HHA does not submit the RAP for CY 2021 or NOA for CYs 2022 and subsequent years within 5 calendar days from the start of care. These regulations are generally incorporated in 42 CFR part 424, subpart P (currently 424.500 through 424.570 and hereinafter occasionally referenced as subpart P). Although this comment only addressed the negative impact on the commenter's geographic area, we believe it is important to note that there are many geographic locations and home health providers that will experience positive impacts upon implementation of the revised CBSA designations. At the end of the day, a pay structure should address four things, Harder explained. I got paid by the hour and driving time was included. The Committee reached consensus on a methodology that resulted in the hospice wage index. As previously described, our policy is to align HHVBP Model data submission requirements with any exceptions or extensions granted for purposes of the HH QRP during the PHE for COVID-19. We acknowledge, however, that two immune-globulins, Xembify and Cutaquig, have been added to the DME LCD for External Infusion Pumps (L33794). 0938-1299. Medicare, and Reporting and recordkeeping requirements. Historically, we have used a value of 0.80 for the loss-sharing ratio, which, we believe, preserves incentives for agencies to attempt to provide care efficiently for outlier cases. Response: Section 1895(b)(5)(A) of the Act allows the Secretary the discretion as to whether or not to have an outlier policy under the HH PPS. Training and education (not otherwise paid for as DME). 15. Home Health Prospective Payment System (HH PPS), 2. We also stated that we expect to see documentation of how such services will be used to help achieve the goals outlined on the plan of care throughout the medical record when such technology is used. SPONSORED BY: Each document posted on the site includes a link to the You can get continuous education through your own efforts. We proposed a transition policy to help mitigate any significant negative impacts that home health agencies may experience due to our proposal to adopt the revised OMB delineations. Therefore, in this final rule we are finalizing conforming regulation text changes at 409.64(a)(2)(ii), 410.170(b), and 484.110 regarding allowed practitioner certification as a condition for payment for home health services. Since the inception of the HH PPS, we have used inpatient hospital wage data in developing a wage index to be applied to home health payments. 16. Therefore, we are not providing any estimated impacts. We then reduced the rates by 5 percent as required by section 1895(b)(3)(C) of the Act, as amended by section 3131(b)(1) of the Affordable Care Act. This Start Printed Page 70342guidance states that the home infusion therapy services benefit is intended to be a separate payment explicitly covering the professional services, training and education (not covered under the DME benefit), and monitoring and remote monitoring services for the provision of home infusion drugs. This repetition of headings to form internal navigation links With respect to the request to extend the reporting exceptions for additional quarters, we note that we did not grant any further exceptions under the HH QRP beyond Q2 of 2020 (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Spotlight-and-Announcements). You can go to the Health Professionals website for a list of certification requirements and the institutions you can find. The HH PRICER module, located within CMS' claims processing system, will increase the CY 2021 30-day base payment rates, described in section III.C.3.b. Similarly, when the Medicare claims processing system receives a Medicare acute or post-acute care claim for an institutional stay, the systems will check for the presence of a home health claim with a community admission source payment group. We explained that under this policy, to the extent CMS has granted an exception to the HH QRP (for 2019 Q4 and 2020 Qs 1 and 2 as noted in the May 2020 COVID-19 IFC and below in this section), or may grant any future exceptions or extensions under this same program for other CY 2020 reporting periods, HHAs in the nine HHVBP Model states do not need to separately report these measures for purposes of the HHVBP Model, and those same exceptions apply to the submission of those same data for the HHVBP Model. We understand commenter concerns about the phase-out of rural add-on payments and potential effects on rural HHAs. Commenters suggested that CMS develop a model for claims reporting and payment for home health visits provided by telecommunications systems. The payment amounts for this final rule are estimated using the proposed CY 2021 rates because the final CY 2021 PFS rates are not available at the time of this rule making. Lastly, the per-visit rates for each discipline are updated by the CY 2021 home health payment update percentage of 2.0 percent. Some commenters expressed concern that beneficiaries would receive fragmented care from multiple visits from various entities and would be required to pay a twenty percent coinsurance for the home infusion therapy services benefit when utilizing both concurrently, whereas they did not have a coinsurance previously under the home health benefit. In 2020, that threshold is approximately $156 million. This final rule establishes Medicare provider enrollment policies for qualified home infusion therapy suppliers. Care coordination between the physician and DME supplier, although likely to include review of the services indicated in the home infusion therapy supplier plan of care, is paid separately from the payment under the home infusion therapy services benefit. It is important to note that the list of home infusion drugs is maintained by the DME MACs and the drugs or their respective payment categories do not need to be updated through rulemaking every time a new drug is added to the DME LCD for External Infusion Pumps (L33794). We believe that in the absence of home health specific wage data, using the pre-floor, pre-reclassified hospital wage data is appropriate and reasonable for home health payments. Is accredited by an organization designated by the Secretary in accordance with section 1834(u)(5) of the Act. Payment category 3 comprises intravenous chemotherapy infusions, including certain chemotherapy drugs and biologicals. Your costs in Original Medicare. We stated that any services that are covered under the home infusion therapy services benefit as outlined at 486.525, including any home infusion therapy services furnished to a Medicare beneficiary that is under a home health plan of care, are excluded from coverage under the Medicare home health benefit. The HHCAHPS has five component questions that together are used to represent one NQF-endorsed measure. We will publish the cost-per-unit amounts for CY 2021 in the rate update change request, which is issued after the publication of the CY 2021 HH PPS final rule. The scope of this license is determined by the ADA, the copyright holder. These bulletins established revised delineations for Metropolitan Statistical Areas, Micropolitan Statistical Areas, and Combined Statistical Areas, and provided guidance on the use of the delineations of these statistical areas. Moreover, it is possible for the principal diagnosis to change between the first and second 30-day period of care and the claim for the second 30-day period of care would reflect the new principal diagnosis. In section V.A.5. To obtain copies of the supporting statement and any related forms for the collections discussed in this rule, please visit the CMS website at www.cms.hhs.gov/PaperworkReductionActof1995,, or call the Reports Clearance Office at (410) 786-1326. Each HHRG has an associated case-mix weight that is used in calculating the payment for a 30-day period of care. Commenters stated that behavior change would not occur 100 percent of the time for all 30-day periods of care. In addition to reading the latest medical news yourself. Specifically, certifications and re-certifications continue on a 60-day basis and the comprehensive assessment must still be completed within 5 days of the start of care date and completed no less frequently than during the last 5 days of every 60 days beginning with the start of care date, as currently required by 484.55, Condition of participation: Comprehensive assessment of patients.. In 424.68(c)(1)(i), we proposed that a home infusion therapy supplier must complete in full and submit the Form CMS-855B application (Medicare Enrollment Application: Clinics/Group Practices and Certain Other Suppliers) (OMB Control No. Therefore, it is anticipated that HHAs have sufficient payment to account for the costs of PPE. Appendix B of the State Operations Manual (regarding home health services) provides detailed examples of auxiliary aids and services.[7]. regulatory information on FederalRegister.gov with the objective of 20-01 was not available in time for development of the proposed rule. 03/01/2023, 159 As such, in the CY 2020 HH PPS final rule with comment period, we finalized a 4.36 percent behavior assumption adjustment in order to calculate the 30-day payment rate in a budget-neutral manner for CY 2020 (84 FR 60511-60519). Section 1834(u)(7)(C) of the Act assigns transitional home infusion drugs, identified by the HCPCS codes for the drugs and biologicals covered under the DME LCD for External Infusion Pumps (L33794),[15] Comment: A few commenters noted that, while helpful for many home health patients, especially those with chronic conditions, CMS should put safeguards in place to ensure that in-person visits are not being replaced by telecommunications technology and that in-person visits remain at adequate levels. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. It may be less than the actual amount a doctor or supplier charges. In accordance with this section, the physician is responsible for coordinating the patient's care in consultation with the DME supplier furnishing the infusion pump and the home infusion drug. On the other hand, this does not mean that such dually-enrolled providers and suppliers can use a single Form CMS-855 to encompass both their NSC enrollment and their Part A/B MAC enrollment. A lot of times, you have nurses or therapists that just go in and do the bare minimum and really dont delve into what else may be happening with the patient. 20-01 (available at https://www.whitehouse.gov/wp-content/uploads/2020/03/Bulletin-20-01.pdf. Comment: Nearly all commenters supported the proposed 2.7 percent increase for a market basket update. Unlike previous rural add-ons, which were applied to all rural areas uniformly, the extension provided varying add-on amounts depending on the rural county (or equivalent area) classification by classifying each rural county (or equivalent area) into one of three distinct categories: (1) Rural counties and equivalent areas in the highest quartile of all counties and equivalent areas based on the number of Medicare home health episodes furnished per 100 individuals who are entitled to, or enrolled for, benefits under Part A of Medicare or enrolled for benefits under Part B of Medicare only, but not enrolled in a Medicare Advantage plan under Part C of Medicare (the High utilization category); (2) rural counties and equivalent areas with a population density of 6 individuals or fewer per square mile of land area and are not included in the High utilization category (the Low population density category); and (3) rural counties and equivalent areas not in either the High utilization or Low population density categories (the All other category). Response: It is unclear how the skilled nursing facility policy finalized during the COVID-19 PHE would translate to the home health benefit beyond the PHE. Response: We appreciate the commenter's support. In a comparison of rates by agency type, RNs in hospital-based home health agencies received the highest in pay with an average hourly rate of $40.10. We also invited comments on any additional interpretations of this notification requirement. From compensation planning to variable pay to pay equity analysis, we surveyed 4,900+ organizations on how they manage compensation. Local Coverage Determination (LCD): External Infusion Pumps (L33794). Interim HealthCare of Oklahoma City is currently recruiting Home Health Registered Nurses (RN). A commenter requested that CMS review and modify the language and definition of PAs and APRNs for home health services, specifically suggesting that CMS defer to state rules that govern the practice of NPs and CNSs with respect to collaboration with the physician and remove references to working in collaboration with the physician in the NP and CNS definitions. Response: We thank the commenter for their support. After extensive impact analysis, consistent with the treatment of these areas under the IPPS as discussed in the FY 2005 IPPS final rule (69 FR 49029 through 49032), we determined the best course of action would be to treat Micropolitan Areas as rural and include them in the calculation of each state's home health rural wage index (see 70 FR 40788 and 70 FR 68132). N/A A supplier may appeal the denial of its enrollment application as a home infusion therapy supplier under part 498 of this chapter. The second column shows the number of facilities in the impact analysis. There are three categories of screening in 424.518: limited, moderate, and high. In accordance with these sections we would increase the single payment amount by the percent increase in the Consumer Price Index for all urban consumers (CPI-U) for the 12-month period ending with June of the preceding year, reduced by the 10-year moving average of changes in annual economy-wide private nonfarm business multifactor productivity (MFP). developer tools pages. Section 1861(iii)(3)(C) of the Act defines a home infusion drug as a parenteral drug or biological administered intravenously or subcutaneously for an administration period of 15 minutes or more, in the home of an individual through a pump that is an item of DME. L. 116-136) included section 3707 related to encouraging use of telecommunications systems for home health services furnished during the COVID-19 PHE. Roswell, GA. $40.00 Per Hour (Employer est.) Consistent with our historical practice, we also proposed to use a more recent estimate of the home health market basket update and the MFP adjustment, if appropriate, to determine the home health payment update percentage for CY 2021 in the final rule. The supplier may subcontract with a pharmacy, physician, other qualified supplier or provider of medical services, in order to meet these requirements. To give you a clearer picture Here are some examples: When a doctor prescribes a medicine to a patient. As outlined in section 1861(iii)(1) of the Act, to be eligible to receive home infusion therapy services under the home infusion therapy services benefit, the patient must be under the care of an applicable provider (defined in section 1861(iii)(3)(A) of the Act as a physician, nurse practitioner, or physician's assistant), and the patient must be under a physician-established plan of care that prescribes the type, amount, and duration of infusion therapy services that are to be furnished. The CY 2021 national, standardized 30-day period payment rate for an HHA that does not submit the required quality data is updated by the CY 2021 home health payment update of 2.0 percent minus 2 percentage points and is shown in Table 8. To better align payment with patient care needs and ensure that clinically complex and ill beneficiaries have adequate access to home health care, in the CY 2019 HH PPS final rule with comment period (83 FR 56406), we finalized case-mix methodology refinements through the Patient-Driven Groupings Model (PDGM) for home health periods of care beginning on or after January 1, 2020. + | COVID Talk; Nursing News; Case Studies (CSI) About Us; Search Search. Has 6 years experience. November 18, 2016. https://downloads.cms.gov/files/hhgm%20technical%20report%20120516%20sxf.pdf. of this final rule, the estimated average annual burden associated with home infusion therapy supplier enrollment over the 3-year OMB approval period is 583 hours at a cost of $28,583. Finally, a few commenters recommended that the home health wage index utilize geographic reclassification and a rural floor like the hospital wage index. For this same reason, we also did not grant further exceptions to HHVBP Model New Measure data submission periods beyond the July 2020 submission period. Section 50401 of the BBA of 2018 amended section 1834(u) of the Act by adding a new paragraph (7) that established a home infusion therapy services temporary transitional payment for eligible home infusion suppliers for certain items and services furnished in coordination with the furnishing of transitional home infusion drugs beginning January 1, 2019. A summary of the comments and our responses are as follows: Comment: Commenters overwhelmingly supported CMS' acknowledgment that telecommunications technology has a place in home health for public health emergencies and beyond. Therefore, in the CY 2020 HH PPS final rule with comment period, we noted that the infusion pump, drug, and other supplies, and the services required to furnish these items (that is, the compounding and dispensing of the drug) remain covered under the DME benefit. A newly Medicare-certified home health agency that is notified of that certification after the Medicare certification date, or which is awaiting its user ID from its Medicare contractor. The quality, utility, and clarity of the information to be collected. 18-04, which superseded the April 10, 2018 OMB Bulletin No. We continue to believe that the 5 percent cap on wage index decreases is the best transition approach for CY 2021. outlining the requirements for the claims processing changes needed to implement this payment. 25. Implementation Date: October 5, 2020. THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. If you want to be a registered nurse you will need more than two years of education and training, however, the good news is that there are more options in terms of accreditation requirements and which institutions you can take. As stated in the May 2020 COVID-19 IFC, we amended the regulations at parts 409, 424, and 484 to define an NP, a CNS, and a PA (as such qualifications are defined at 410.74 through 410.76) as an allowed practitioner (85 FR 27572). Ensures the safe and effective provision and administration of home infusion therapy on a 7-day-a-week, 24-hour-a-day basis. Furthermore, a 5 percent cap on wage index decreases in CY 2021 provides a degree of predictability in payment changes for providers and allows providers time to adjust to any significant decreases they may face in CY 2022, after the transition period has ended. Consistent with section 1861(iii)(3)(D)(i)(III) of the Act (codified in 486.505), we proposed in new 424.68(c)(3) that a home infusion therapy supplier must be currently and validly accredited as such by a CMS-recognized home infusion therapy supplier accreditation organization in order to enroll and remain enrolled in Medicare. We note that Office of the Federal Register issued a correction to the comment period closing date for the CY 2021 HH PPS proposed rule in the July 20, 2020 Federal Register (85 FR 43805). RN Pay Per Visit Grid RHCD Years of Service Year 1-3 Year 4-6 Year 7-9 Year 10+ Labor Pool** SN, SNDC Weekday. This commenter is correct, and as noted previously, the FDL ratio for CY 2021 will be 0.56. Please note that students must pay both fees when receiving Ministry of Education tuition assistance. Payment Under the Home Health Prospective Payment System (HH PPS), A. CY 2021 PDGM Low-Utilization Payment Adjustment (LUPA) Thresholds and PDGM Case-Mix Weights, 1. documents in the last year, 940 General Enrollment and Payment Requirement, c. Specific Requirements for Home Infusion Therapy Supplier Enrollment, (1) Submission of Form CMS-855 and Certification, (4) Home Infusion Therapy Supplier Standards, d. Denial of Enrollment and Appeals Thereof, e. Continued Compliance, Standards, and Reasons for Revocation, f. Effective and Retrospective Date of Home Infusion Therapy Supplier Billing Privileges, VII. The HH QRP currently includes 20 measures for the CY 2022 program year.[8]. Response: Section 1895(b)(3)(B) of the Act requires that the standard prospective payment amounts for CY 2021 be increased by a factor equal to the applicable home health market basket percentage increase reduced by the MFP adjustment, and as such, we have no statutory or regulatory discretion in this matter. 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